Trapped Prostate

Turner-Warwick introduced the term trapped prostate to describe the small obstructing prostate trapped between the bladder neck and the external sphincter (12). Today, this poorly understood cause of LUTS in men is termed primary bladder neck obstruction, Marion's disease, (13) dysfunctional bladder neck, (14) or bladder neck dyssynergia (15,16). Often, these men are young (age 20-50 yr), with long-standing obstructive and irritative voiding symptoms, and often they have been misdiagnosed with chronic nonbacterial prostatitis, neurogenic bladder dysfunction, or psychogenic voiding dysfunction (8-10,14). Video urodynamics and pressure-flow studies demonstrate elevated detrusor pressures, decreased urine flow rates, and obstruction at the bladder neck as noted previously. Although the cause of this disorder is not clear, abnormalities of the bladder neck musculature and sympathetic nervous dysfunction have been implicated, providing the rationale for use of a-blocking agents (9,12,16,17). Although most patients initially choose a-blocker therapy, few realize adequate long-term relief (8). In contrast, 87% of men report adequate relief of symptoms after transurethral incision (18). Transurethral incision of the bladder neck is the standard treatment for primary bladder neck obstruction and is effective at improving urinary flow rates and lower urinary tract symptoms (8-10,14).

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